Antepartum, Maternal And Newborn – Newborn: Care of Newborn with Hyperbilirubinemia SECTION: 19.10

Strength of Evidence Level: 3 __RN__LPN/LVN__HHA

PURPOSE:

To provide skilled nursing care to newborns with diagnoses of hyperbilirubinemia.

CONSIDERATIONS:

1. Newborn jaundice occurs when the newborn’s liver is not able to get rid of extra bilirubin on its own. Bilirubin is a yellow chemical that accumulates in the blood when red blood cells are naturally broken down as new red blood cells are formed.

2. In most cases, jaundice will appear at about the second or third day of life and disappear by 2 weeks of age. Visible jaundice develops in at least 50 percent of all infants.

3. A transcutaneous bilirubin (TcB) and/or Total Serum Bilirubin (TSB) should be performed if the jaundice appears excessive for the infant’s age. If there is any doubt that there is jaundice, the TcB or TSB should be measured. Visual estimation of bilirubin levels can lead to errors, particularly in darkly pigmented infants.

4. All bilirubin levels should be interpreted according to the infant’s age in HOURS.

5. Follow manufacturer’s instructions for use of TcB devices.

EQUIPMENT:

Scale

Stethoscope and sphygmomanometer

Sterile lancet

Pedi “bullet’ lab tubes

Alcohol sponge

Gauze or cotton ball

Self-adhesive bandage

Impervious trash bags

Gloves

Puncture-proof container

Transcutaneous Bilirubin Device (optional)

PROCEDURE:

1. Adhere to Standard Precautions. 2. Identify the patient and explain the procedure to

caregiver and patient, if age appropriate. 3. Assess patient for the following:

a. Visual presence of jaundice. b. Weigh the patient, to determine gain or loss. c. Adequacy of intake. d. Pattern of voiding and stooling.

4. Perform a TcB or a heelstick (See Capillary Blood Samples) or TSB, per physician order, for adequate bilirubin level.

5. Call physician with bilirubin result and obtain further instructions, which may include home phototherapy (See Antepartum, Maternal, Newborn- Home

Phototherapy procedure) or a repeat TcB or TSB the following day.

AFTER CARE:

1. Instruct caregiver: a. To observe for signs of increased

jaundice/bilirubin levels. b. To monitor wet diapers and stooling. c. Ensure adequate nutritional intake whether

breastfeeding or formula feeding. d. To call physician if symptoms worsen or if

newborn has decreased urinary output/stools or increased lethargy.

2. Document in patient’s record: a. Procedure and observations. b. Physician instructions for follow-up. c. Instructions given to caregiver.

981 Last Update 9/10

982 Last Update 9/10